Giant Cell Arteritis (Temporal Arteritis)

What is Giant Cell Arteritis?

Giant cell arteritis is a chronic inflammation of the walls of large and medium-sized arteries, found mainly in people older than 50, that most often involves the branches of the carotid arteries in the head.^[1] It is also called temporal arteritis. It is the most common form of systemic vasculitis in this age group.^[2]

Giant cell arteritis is a medical emergency. Inflammation can block blood flow to the eye and cause permanent vision loss, so treatment must start quickly under a physician's care.^{[1, 3]}

Common symptoms

Cranial involvement can bring a new headache, scalp tenderness, jaw pain when chewing, fatigue, fever and weight loss.^{[1, 4]} Jaw pain with chewing, temporal artery thickening and tenderness, and limb pain with walking are among the features that point most strongly toward the diagnosis, though no single feature confirms or rules it out.^[5]

Vision loss, often first noticed as brief loss of vision in one eye, is the most serious complication.^[1] Many people also have polymyalgia rheumatica, with aching and stiffness in the shoulders and hips.^{[1, 6]} When the aorta and its branches are involved, symptoms can be vague, such as tiredness, fever and weight loss.^[2]

Causes and risk factors

The cause is not fully known. It is an immune-mediated disease that occurs mainly in older adults, and it is more common in women.^[1] Its link with polymyalgia rheumatica is strong.^[7]

How it is diagnosed and treated conventionally

Diagnosis combines symptoms, blood tests of inflammation, imaging and, often, a temporal artery biopsy, and no single feature is enough on its own.^{[1, 5]} An elevated erythrocyte sedimentation rate and C-reactive protein are common, but they are not proof.^[5]

Treatment is urgent. High-dose systemic glucocorticoids are started early to prevent vision loss and may be combined with an interleukin-6 receptor blocker.^[1] A Cochrane review of two trials (281 people) found that tocilizumab, an interleukin-6 blocker, increased sustained remission, with moderate-certainty evidence.^[8] The American College of Rheumatology guideline recommends glucocorticoid-sparing immune-suppressing medicines and imaging to look for large-vessel involvement.^[9] Treat-to-target recommendations aim for remission, prevention of damage to the arteries, and good quality of life.^[3]

Why Giant Cell Arteritis calls for a whole-person approach

The arterial inflammation itself needs medical treatment. Around that, people often cope with a long course of steroids, relapses, fatigue, aching, poor sleep and worry. Those are the areas where supportive care can sit alongside medical care.

A few factors are worth understanding.

Immune-driven inflammation

Interleukin-6 signaling is thought to drive inflammation and general symptoms such as fatigue, fever and weight loss in related disease.^[7] This is why anything claiming to act on the immune system must be reviewed by your physicians first.

Long-term steroid treatment

People may need glucocorticoids for extended periods, and this is linked to high rates of side effects such as diabetes and osteoporosis in the closely related condition polymyalgia rheumatica.^{[6, 7]} Your physicians monitor these effects and decide on bone and blood sugar care.

Pain, aching and relapses

In polymyalgia rheumatica, aching and stiffness can return when steroid doses are lowered, and relapse may be hard to tell apart from other causes of pain.^[6] Any new or returning symptom should be assessed by your physician rather than treated as ordinary pain.

Sleep and stress

Living with a serious, long-term condition often affects sleep and mood. Sleep problems are a symptom that supportive care can reasonably address.^[10]

Acupuncture as supportive care in Giant Cell Arteritis

What the research shows

No clinical trials of acupuncture for giant cell arteritis were found. The studies below concern general symptoms, not this disease, and the headache of giant cell arteritis must never be treated as an ordinary headache.

An individual patient data meta-analysis of 39 trials (20,827 patients) found acupuncture reduced chronic musculoskeletal pain, osteoarthritis pain, headache and shoulder pain more than no acupuncture or sham needling, with effects lasting over a year. The difference from sham was small, about 0.2 standard deviations.^[11] A systematic review of 24 trials of acupuncture for insomnia included a meta-analysis of 15 trials suggesting better sleep scores than with medication after about three weeks, though the results varied widely between studies.^[10]

These findings apply to people without this disease. We do not know how they carry over to giant cell arteritis or to the aches that come with steroid tapering.

How acupuncture may work

How acupuncture might work for pain and sleep is not settled, and we do not claim any mechanism as established. Acupuncture does not treat arterial inflammation, and there is no evidence that it does.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with a short course of visits and reassessment. In prospective studies, about 9 in 100 patients had a minor reaction such as soreness or bleeding at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12]

Tell the practitioner first if you take aspirin, blood thinners or immune-suppressing medicines, have a bleeding disorder, have osteoporosis or fragile skin from long-term steroids, are pregnant, or have a pacemaker if electroacupuncture is being considered. Supportive care is only appropriate once your rheumatology or other specialist team is managing the disease and knows about it. New headache, scalp tenderness, jaw pain or vision changes must be evaluated urgently, not treated here.

Ayurvedic medicine as supportive care in Giant Cell Arteritis

The Ayurvedic view

Ayurveda has no classical diagnosis that matches giant cell arteritis. Practitioners may describe a chronic inflammatory illness with fever, tiredness and pain in terms of imbalance of the doshas, particularly excess heat, and of disturbed blood. These are traditional frameworks and not biomedical explanations.

Therapies that may be used

For someone under specialist care, Ayurvedic support is limited to gentle measures:

• Regular meals and daily routines that suit the person, fitted with any diet advice from your physicians
• Relaxation, breathing practices and gentle oil massage for stress and sleep
• Herbs, only if your physicians agree, chosen individually and checked against your medicines

Panchakarma is not appropriate. It is not appropriate during acute illness, frailty or pregnancy, in older people on high-dose steroids, or while a serious inflammatory disease is being brought under control.

What the research shows

No studies of Ayurvedic medicine for giant cell arteritis were found. We cannot say whether Ayurvedic therapies help this condition.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic in one study, with the highest rates in products made with metals and minerals.^[13] This is a reason to use only tested products chosen by a qualified practitioner. Ayurvedic herbs, like other herbs, can also interact with prescribed medicines.^[14]

Herbal medicine as supportive care in Giant Cell Arteritis

Herbs and formulas that have been studied

No herb or formula has been tested in giant cell arteritis. We searched PubMed for Chinese herbal medicine, traditional Chinese medicine and other herbal therapy in giant cell arteritis and temporal arteritis, and found no clinical trials. Practitioners of traditional Chinese medicine may use formulas chosen for patterns such as heat, blood stasis or deficiency, but there is no evidence that any formula treats this disease.

What the research shows

There is no clinical research on herbal medicine for giant cell arteritis. Because the disease can cause blindness and is treated with strong immune-suppressing drugs, herbs that claim to act on inflammation or immunity should never replace that treatment, and should not be added to it without your physicians' approval.

Safety and herb-drug interactions

Herbs can interact with the medicines used for this condition. Reviews describe bleeding when warfarin is combined with herbs such as dan shen, dang gui, ginger, ginseng and Boswellia, and bleeding when ginkgo is combined with aspirin or warfarin.^{[14, 15]} That matters because aspirin or other antiplatelet drugs are sometimes used in giant cell arteritis.^[1] St John's wort lowered blood levels of cyclosporine and tacrolimus.^[14]

Liver injury from herbal and dietary supplements is also well documented.^[16] No one with this condition should start any herb or supplement without approval from their physician or pharmacist. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Traditional Chinese medicine may describe temple headache with fever and fatigue as heat and blood stasis in the channels, and Ayurveda describes excess heat and disturbed blood. Researchers instead study immune-mediated arterial inflammation, interleukin-6 signaling, and symptom measures such as pain and sleep.^{[1, 7]}

No study has shown that a traditional pattern corresponds to this disease.

How this care fits with your medical care

Supportive care here is complementary only. Stay with your rheumatologist, eye specialist and primary care physician, take every prescribed medicine exactly as directed, and do not stop or change steroids or other medicines on your own. Stopping steroids suddenly can be dangerous. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or manage giant cell arteritis. Please bring your diagnosis, your medicine list including steroid dose, recent blood test results, and notes about any eye findings.

When to seek urgent medical care

Possible giant cell arteritis is treated as an emergency, because vision loss can be sudden and permanent.^{[1, 3]}

• Any sudden loss of vision, even brief, or double vision
• New headache, scalp tenderness or jaw pain when chewing in a person over 50
• Fever, night sweats or weight loss with these symptoms
• Weakness, trouble speaking or face drooping, which may signal a stroke
• Severe chest, back or abdominal pain
• Symptoms returning as steroid doses are lowered

If any of these occur, call 911 or go to the nearest emergency department. For returning symptoms, call your physician the same day.